Surgical Access Device

ABSTRACT

Various devices are provided for allowing multiple surgical instruments to be inserted through a single surgical access device at variable angles of insertion, allowing for ease of manipulation within a patient&#39;s body while maintaining insufflation. Safety shields and release mechanisms are also provided for use with various surgical access devices.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/408,544, filed Jan. 18, 2017 and entitled “Surgical Access Device,”which is a continuation of U.S. patent application Ser. No. 14/819,716(now U.S. Pat. No. 9,687,272), filed Aug. 6, 2015 and entitled “SurgicalAccess Device,” which is a continuation of U.S. patent application Ser.No. 13/922,957 (now U.S. Pat. No. 9,131,835), filed Jun. 20, 2013 andentitled “Surgical Access Device,” which is a continuation of U.S.patent application Ser. No. 12/242,765 (now U.S. Pat. No. 8,485,970),filed Sep. 30, 2008 and entitled “Surgical Access Device,” which arehereby incorporated by reference in their entireties.

FIELD OF THE INVENTION

The present invention relates to surgical access devices for providingsurgical access into a body cavity.

BACKGROUND OF THE INVENTION

Abdominal laparoscopic surgery gained popularity in the late 1980's,when benefits of laparoscopic removal of the gallbladder overtraditional (open) operation became evident. Reduced postoperativerecovery time, markedly decreased post-operative pain and woundinfection, and improved cosmetic outcome are well established benefitsof laparoscopic surgery, derived mainly from the ability of laparoscopicsurgeons to perform an operation utilizing smaller incisions of the bodycavity wall.

Laparoscopic procedures generally involve insufflation of the abdominalcavity with CO2 gas to a pressure of around 15 mm Hg. The abdominal wallis pierced and a 5-10 mm in diameter straight tubular cannula or trocarsleeve is then inserted into the abdominal cavity. A laparoscopictelescope connected to an operating room monitor is used to visualizethe operative field, and is placed through the trocar sleeve.Laparoscopic instruments (graspers, dissectors, scissors, retractors,etc.) are placed through two or more additional trocar sleeves for themanipulations by the surgeon and surgical assistant(s).

Recently, so-called “mini-laparoscopy” has been introduced utilizing 2-3mm diameter straight trocar sleeves and laparoscopic instruments. Whensuccessful, mini-laparoscopy allows further reduction of abdominal walltrauma and improved cosmesis. Instruments used for mini-laparoscopicprocedures are, however, generally more expensive and fragile. Becauseof their performance limitations, due to their smaller diameter (weaksuction-irrigation system, poor durability, decreased video quality),mini-laparoscopic instruments can generally be used only on selectedpatients with favorable anatomy (thin cavity wall, few adhesions,minimal inflammation, etc.). These patients represent a small percentageof patients requiring laparoscopic procedures. In addition, smaller 2-3mm incisions may still cause undesirable cosmetic outcomes and woundcomplications (bleeding, infection, pain, keloid formation, etc.).

Since the benefits of smaller and fewer body cavity incisions areproven, it would be desirable to perform an operation utilizing only asingle incision in the navel. An umbilicus is well-hidden and thethinnest and least vascularized area of the abdominal wall. Theumbilicus is generally a preferred choice of abdominal cavity entry inlaparoscopic procedures. An umbilical incision can be easily enlarged(in order to eviscerate a larger specimen) without significantlycompromising cosmesis and without increasing the chances of woundcomplications. The placement of two or more standard (straight) cannulasand laparoscopic instruments in the umbilicus, next to each other,creates a so-called “chopstick” effect, which describes interferencebetween the surgeon's hands, between the surgeon's hands and theinstruments, and between the instruments. This interference greatlyreduces the surgeon's ability to perform a described procedure.

Thus, there is a need for instruments and trocar systems which allowlaparoscopic procedures to be performed entirely through the umbilicusor a surgical port located elsewhere while at the same time reducing oreliminating the “chopstick effect.”

SUMMARY OF THE INVENTION

The present invention generally provides devices for allowing surgicalaccess to an interior of a patient's body. In one embodiment, a surgicalaccess device is provided and can include a retractor having an openingextending therethrough for forming a pathway through tissue into a bodycavity. A housing can be coupled to the retractor and can define alongitudinal axis extending therethrough. The housing can include aplurality of rigid sealing ports in communication with the opening inthe retractor. In some embodiments, each sealing port can have a sealingelement therein and can having a central axis that forms an angle withthe longitudinal axis of the housing that is greater than zero. Thecentral axis of each sealing port can be different than the central axisof every other sealing port.

In one exemplary embodiment, at least one of the sealing ports can havean opening with a diameter different than a diameter of an opening inthe other sealing ports. The sealing ports can be rotatable relative tothe housing and two or more sealing ports can be rotatable as a unitwith respect to the housing. Each sealing element can be configured forlateral and pivotal movement and can be freely movable relative to thehousing such that the angular orientation of the central axis isadjustable. In one embodiment, an adapter can be removably matable to atleast one of the sealing ports to change an effective diameter of thesealing port. In other embodiments, the adapter can have a non-circularcross-section to receive and form a seal with a surgical instrumenthaving a non-circular cross-section.

While the housing can have any configuration, in one embodiment, thehousing is movable between a convex configuration and a concaveconfiguration. The housing can be rotatable relative to the retractor. Aflexible connector, for example a bellows, can extend between thehousing and the retractor to allow the housing to move polyaxiallyrelative to the retractor. In some embodiments, the housing can behingedly connected to the retractor. The retractor can include aproximal flange and a distal flange having a flexible cylindricalportion extending therebetween. The housing can include a distal annulusthat releasably couples to the proximal flange of the retractor. Thesurgical access device can also include a release mechanism configuredto allow selective engagement and disengagement of the housing with theretractor.

In another exemplary embodiment, the surgical access device can includea flexible shield disposed within the retractor and configured toprotect the retractor from damage caused by insertion of surgicalinstruments through the sealing ports and the retractor. The retractorcan optionally include a lighting element disposed thereon to allowillumination of a body cavity.

In another embodiment, a surgical access device is provided and caninclude a housing having a plurality of rigid sealing ports with sealingelements therein for receiving surgical instruments. The plurality ofsealing ports can have central axes extending therethrough that differfrom one another. In some embodiments, the central axes of the sealingports can be different than a central longitudinal axis of the housingand at least one of the sealing ports can be rotatable relative to thehousing.

The surgical access device can further include a flexible cannulaextending distally from the housing for receiving surgical instrumentsinserted through the sealing ports. In one exemplary embodiment, thehousing can be rotatable relative to the flexible cannula. The housingcan optionally be flexible and movable between a convex configurationand concave configuration to allow reorientation of the central axes ofthe sealing ports.

In other aspects, a surgical access device is provided and can include ahousing having a plurality of sealing ports. Each sealing port can havea seal with a non-circular opening configured to form a seal around aninstrument having a non-circular cross-section, and each seal can berotatable relative to the housing to allow the seal to rotate with andmaintain a seal around an instrument inserted therethrough. In someembodiments, each seal can have a different non-circular opening shape,and the non-circular opening in at least one of the seals can have ashape that can include, but is not limited to, triangular,quadrilateral, and oval. The surgical access device can further includea retractor extending from the housing that can have an opening formedtherethough for receiving surgical instruments. The housing can berotatable relative to the retractor, and the seals can float relative tothe retractor.

In another exemplary embodiment, a surgical access device is providedand can include a retractor having an opening extending therethrough anda housing coupled to the retractor and having a plurality of sealingports. The housing can be freely rotatable relative to the retractor toallow positioning of surgical instruments through the sealing portsduring use. The sealing ports can optionally be positionednon-symmetrically within the housing. The surgical access device canalso include a base ring disposed between the retractor and the housingand configured to allow rotation of the housing. A release mechanism canbe releasably mated to the retractor and the housing and can beconfigured to allow decoupling of the housing from the retractor. Insome embodiments, at least one of the sealing ports can be oriented tohave a central axis different than a central longitudinal axis of thehousing and the retractor, and at least one of the sealing ports can berotatable relative to the housing. In addition, at least one sealingport can have a seal element that extends in a plane that forms an anglewith a central longitudinal axis of the housing, and the angle betweenthe plane and the central longitudinal axis of the housing can beadjustable.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a flexible cannula extending therefromthat can be configured for guiding a surgical instrument into apatient's body. A sealing element can be disposed within the housing andconfigured to receive a surgical instrument. The sealing element can berotatable relative to the housing to allow a surgical device insertedthrough the sealing element and the flexible cannula to rotate thereinwithout causing the flexible cannula to rotate. The sealing element canbe disposed within an opening formed through the housing and can includeat least one of an instrument seal for forming a seal around a surgicalinstrument and a channel seal for forming a seal in the opening when noinstrument is inserted therethrough. In some embodiments, the surgicalaccess device can further include steering cables coupled to theflexible cannula and configured to steer the flexible cannula along atortuous pathway. A locking mechanism can also be included for lockingrotational motion of the sealing element relative to the housing and theflexible cannula.

Various shields and collars can be used with the various embodiments ofsurgical access devices, and in one exemplary embodiment, a surgicalaccess device is provided and can include a retractor having an openingextending therethrough for forming a pathway through tissue into a bodycavity. A housing can be coupled to the retractor and can have aplurality of sealing ports for receiving surgical instruments. Aflexible shield can be disposed within the retractor and it can beconfigured to protect tissue from damage caused by the insertion ofsurgical instruments through the sealing ports and the retractor. Insome embodiments, the flexible shield can have a length at least as longas a length of the retractor. In other embodiments, the flexible shieldcan have a length that is greater than a length of the retractor.

The flexible shield can be coupled to the housing and can be configuredto extend therefrom into a body cavity of a patient in which surgery isperformed. Steering cables can be coupled to the flexible shield andconfigured to steer the flexible shield along a tortuous pathway. In oneembodiment, the flexible shield can be removably coupled to the housingand can be formed from any suitable material known in the art including,but not limited to, silicone, urethane, thermoplastic elastomer, rubber,polyolefins, polyesters, nylons, and fluoropolymers. Each sealing portcan have a central axis that differs from one another and that differsfrom a central longitudinal axis of the housing. The housing can berotatable relative to the retractor and at least one of the sealingports can be rotatable relative to the housing. In some embodiments, thesurgical access device can further include a flexible connectorextending between the housing and the retractor to allow the housing tomove polyaxially relative to the retractor. As such, the flexible shieldcan extend through the flexible connector and the retractor.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a plurality of sealing ports forreceiving surgical instruments. A retractor can be positionable in anopening of a patient's body and can extend distally from the housing forreceiving surgical instruments inserted through the sealing ports. Acollar can extend proximally from the housing and can be configured toprotect tissue from damage caused by insertion of surgical instrumentsadvanced into the sealing ports of the housing. The collar can have asubstantially conical shape with a distal opening and a proximalopening, and the distal opening can receive a base of the housing. Inone embodiment, at least a distal portion of the collar is substantiallyrigid and can be formed of, for example, polycarbonate or high densitypolyethylene. In other embodiments, at least a proximal portion of thecollar is substantially flexible and can be formed of, for example,silicone, urethane, thermoplastic elastomer, and rubber.

The collar can include a releasable securing element on a distal portionthereof for releasably securing the collar to the housing. In oneembodiment, the securing element can be one or more cantilevered snaps.In addition, the collar can have a plurality of suture holes disposedaround a proximal portion thereof for securing the collar to tissue. Thehousing can be rotatable relative to the retractor and rotation of thecollar can be effective to rotate the housing. In some embodiments, thecollar can include guide markings for orienting the housing and forguiding surgical instruments into the sealing ports.

In one exemplary embodiment, a surgical access device is provided andcan include a base ring having a proximal facing surface and a distalfacing surface, a retractor extending distally from the distal facingsurface of the base ring, and a housing extending proximally from theproximal facing surface of the base ring. The housing can have aplurality of sealing ports, and a shield can extend distally from thebase ring through an interior of the retractor. The shield can beconfigured to protect the retractor from damage caused by insertion ofsurgical instruments therethrough.

In some embodiments, the shield can be releasably coupled to the basering and can have a length that is greater than a length of theretractor. Steering cables can be coupled to the flexible shield andconfigured to steer the flexible shield along a tortuous pathway. Thesurgical access device can also include a release mechanism for removingthe collar from the base ring. In one embodiment, the surgical accessdevice can include a plurality of shields extending distally from eachof the plurality of sealing ports.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a plurality of access ports. Eachaccess port can include a seal element having a slit adapted forselectively opening and closing to seal the access port when noinstrument is passed therethrough. In addition, each slit can extendsubstantially tangential to a circumference of the housing. At least oneof the seal elements can have a maximum diameter when opened that isdifferent than a maximum diameter of another one of the seal elementswhen opened.

In some embodiments, a proximal most portion of at least one of the sealelements can be flush with a proximal most portion of the housing. Inother embodiments, a proximal most portion of at least one of the sealelements can be at a position proximal to a proximal most portion of thehousing. In still further embodiments, a proximal most portion of atleast one of the seal elements can be at a position distal to a proximalmost portion of the housing. Each access port can have a central axisthat differs from one another and at least one of the seal elements canbe rotatable relative to the housing. In one embodiment, an adapter canbe removably matable to at least one of the access ports to change aneffective diameter of the access port. In addition, at least one of theaccess ports can include a second seal element having an opening with anon-circular shape for forming a seal around a surgical instrument witha non-circular cross-section.

The surgical access device can also include a retractor extending fromthe housing and having an opening for receiving surgical instrumentsinserted through the access ports. The housing can be rotatable relativeto the retractor. The surgical access device can also include a flexibleconnector, for example a bellows, extending between the housing and theretractor to allow the housing to move polyaxially relative to theretractor. In one embodiment, the housing can be hingedly connected tothe retractor by a flexible connector. The surgical access device canalso include a release mechanism that selectively engages and disengagesthe housing and the retractor. A flexible shield can be disposed withinthe retractor and configured to protect the retractor from damage causedby insertion of surgical instruments through the access ports and theretractor. The retractor can include a lighting element disposed thereonto allow illumination of a body cavity.

In other aspects, a surgical access device is provided and can include aretractor having an opening extending therethrough for forming a pathwaythrough tissue into a body cavity, a housing having a plurality ofsealing ports, and a release mechanism configured to releasably mate thehousing to the retractor. In some embodiments, the housing can include abase ring and the retractor can include a proximal flange. The releasemechanism can engage the base ring and the proximal flange to mate thehousing to the retractor. In one exemplary embodiment, the releasemechanism can be a C-clamp selectively positionable around the base ringand the proximal flange to mate the housing with the retractor. Therelease mechanism can also be a latch formed on the proximal flange andconfigured to selectively engage and disengage the base ring. Therelease mechanism can take any form known in the art including, but notlimited to, a push button, a switch, and a trigger. The releasemechanism can also be effective to lock the housing in a desiredrotational position.

In some embodiments, each sealing port can have an opening formedthrough the housing and can have at least one of an instrument seal forforming a seal around a surgical instrument inserted therethrough and achannel seal for forming a seal in the opening when no instrument isinserted therethrough. Each sealing port can have a central axis thatdiffers from one another and at least one of the sealing ports can berotatable relative to the housing. In other embodiments, the housing canbe rotatable relative to the retractor. The surgical access device canalso include a flexible shield disposed within the retractor andconfigured to protect the retractor from damage caused by insertion ofsurgical instruments through the sealing ports and the retractor. Inaddition, there can be a plurality of housings having a plurality ofsealing ports and each housing can be interchangeable with the others.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a plurality of access ports withduckbill seals extending distally therefrom and a retractor extendingdistally from the housing. A mid-portion of the retractor can have adiameter that is less than a diameter of the housing. The duckbill sealscan be oriented to minimize unintentional contact by the retractor withthe seals that would cause the seals to open. For example, each duckbillseal can include a slit configured to selectively open and close, andthe slits can be oriented tangentially to a circumference of thehousing.

In some embodiments, at least one of the access ports can have anopening with a diameter different than a diameter of an opening in theother access ports and each access port can have a central axis thatdiffers from one another. In addition, at least one of the duckbillseals can be positioned distally to the other duckbill seals. In otherembodiments, at least one of the duckbill seals can extend into themid-portion of the retractor and at least one of the duckbill seals canbe rotatable relative to the housing.

An adapter can be removably matable to at least one of the access portsto change an effective diameter of the access port. In one embodiment,at least one of the access ports can include an instrument seal havingan opening with a non-circular shape configured to form a seal around asurgical instrument with a non-circular cross-section. In addition, thehousing can be rotatable relative to the retractor. The surgical accessdevice can further include a connector extending between the housing andthe retractor to allow the housing to move relative to the retractor. Arelease mechanism can be configured to allow selective engagement anddisengagement of the housing with the retractor. In some embodiments, aflexible shield can be disposed within the retractor and configured toprotect the retractor from damage caused by insertion of surgicalinstruments through the access ports and the retractor.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a flexible base with a plurality ofrigid sealing ports extending therethrough that can have a sealingelement therein. The flexible base can be movable to allow each sealingport to selectively position instruments extending through the sealingelement at converging and diverging positions relative to one another.The flexible base can be movable between a convex configuration and aconcave configuration. Each sealing port within the housing can beselectively movable between a proximal position within the housing and adistal position within the housing.

The surgical access device can also include a retractor extendingdistally from the housing and configured to form an opening throughtissue for receiving instruments inserted through the sealing ports. Thehousing can include a distal annulus that releasably couples to aproximal flange on the retractor and can be rotatable relative to theretractor. In some embodiments, each sealing port can have a centralaxis that differs from one another and that differs from a centrallongitudinal axis of the housing. At least one of the sealing ports canhave an opening with a diameter different than a diameter of an openingin the other sealing ports. In one exemplary embodiment, at least one ofthe sealing ports can have a non-circular opening and can be rotatablerelative to the flexible base.

The surgical access device can also include a flexible connectorextending between the housing and the retractor to allow the housing tomove relative to the retractor, and the housing can be hingedlyconnected to the retractor. A release mechanism can be configured toallow selective engagement and disengagement of the housing with theretractor. In one embodiment, a flexible shield can be disposed withinthe retractor and configured to protect the retractor from damage causedby insertion of surgical instruments through the sealing ports and theretractor. The retractor can also include a lighting element disposedthereon to allow illumination of a body cavity. In some embodiments,each sealing port includes at least one of an instrument seal configuredto form a seal around an instrument inserted therethrough and a channelseal configured to seal the access port when no instrument is insertedtherethrough.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a plurality of rigid sealing ports withsealing elements therein for receiving surgical instruments. Eachsealing port can be individually movable independent of the housing suchthat each sealing port has a full range of lateral and vertical motion,and combinations thereof, relative to the housing. The plurality ofsealing ports can be disposed in a flexible base that is movable betweena convex configuration and a concave configuration. A retractor canextend distally from the housing and can be configured to form anopening through tissue for receiving instruments inserted through thesealing ports.

In one embodiment, the housing can include a distal annulus thatreleasably couples to a proximal flange on the retractor, and thehousing can be rotatable relative to the retractor. Each sealing portcan have a central axis that differs from one another and that differsfrom a central longitudinal axis of the housing. At least one of thesealing ports can have an opening with a diameter different than adiameter of an opening in the other sealing ports. In addition, at leastone of the sealing ports can be rotatable relative to the housing. Anadapter can be removably matable to at least one of the sealing ports tochange an effective diameter of the sealing port.

The surgical access device can also include a flexible connectorextending between the housing and the retractor to allow the housing tomove relative to the retractor. A release mechanism can be configured toallow selective engagement and disengagement of the housing with theretractor. In other embodiments, a flexible shield can be disposedwithin the retractor and configured to protect the retractor from damagecaused by insertion of surgical instruments through the sealing portsand the retractor.

In another embodiment, a surgical access device is provided and caninclude a housing having a retractor extending therefrom that can beconfigured to form a pathway through tissue. The housing can alsoinclude a plurality of rigid sealing ports having sealing elementstherein for receiving surgical instruments therethrough. Each sealingelement can be freely movable relative to one another, relative to thehousing, and relative to tissue when the retractor is positioned intissue. Each sealing element can be disposed in a flexible base coupledto the housing. In some embodiments, the flexible base can be movablebetween convex and concave positions to move the sealing ports. In otherembodiments, each sealing element can freely move laterally, vertically,rotationally, and combinations thereof.

In one embodiment, the housing can be rotatable relative to theretractor and each sealing port can have a central axis that differsfrom one another and that differs from a central longitudinal axis ofthe housing. A connector can extend between the housing and theretractor to allow the housing to move relative to the retractor. Thesurgical access device can further include a release mechanismconfigured to allow selective engagement and disengagement of thehousing with the retractor. A flexible shield can be disposed within theretractor and configured to protect the retractor from damage caused byinsertion of surgical instruments through the sealing ports and theretractor.

In another exemplary embodiment, a surgical access device is providedand can include a housing having a plurality of sealing ports forreceiving surgical instruments, a retractor having an opening formedtherethrough for providing a pathway through tissue for surgicalinstruments inserted through the plurality of sealing ports, and aconnector coupled between the housing and the retractor that can allowthe housing to have a full range of lateral and vertical motion relativeto the retractor. In some embodiments, the connector can allowrotational motion of the housing relative to the retractor and can havea proximal flange and a distal flange and a flexible cylindrical portionextending therebetween. While the connector can be formed of anysuitable material known in the art, in one embodiment, the connector canbe formed from an elastomeric material.

The housing can optionally be rotatable relative to the connector and atleast one sealing port can be rotatable relative to the housing. Eachsealing port can have a central axis that differs from one another andthat differs from a central longitudinal axis of the housing. Thesurgical access device can also include a flexible shield disposedwithin the retractor and configured to protect the retractor from damagecaused by insertion of surgical instruments through the sealing portsand the retractor.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a perspective view of one embodiment of a surgical accessdevice having a plurality of off-axis sealing ports extendingtherethrough;

FIG. 1B is a perspective view of the surgical access device of FIG. 1Aillustrating a surgical instrument extending through one of the sealingports;

FIG. 1C is an exploded view of the surgical access device of FIG. 1A;

FIG. 1D is a cross-sectional view of the surgical access device andinstrument of FIG. 1B;

FIG. 1E is a perspective view of one embodiment of a duckbill sealingelement for use in a surgical access device;

FIG. 2A is a top view of one embodiment of a surgical access deviceshowing two sealing ports on a rotatable stage;

FIG. 2B is a top view of the surgical access device of FIG. 2A showingthe rotatable stage in a rotated position;

FIG. 3A is a perspective view of the surgical access device of FIG. 1Ahaving a flexible connector in a compressed condition;

FIG. 3B is a perspective view of the surgical access device of FIG. 3Ashowing the flexible connector in an expanded configuration;

FIG. 3C is an exploded view of the surgical access device of FIG. 3A;

FIG. 3D is a cross-sectional view of the surgical access device of FIG.3A;

FIG. 4A is a perspective view of the surgical access device of FIG. 3Ashowing a hinge associated with the flexible connector;

FIG. 4B is a cross-sectional view of the surgical access device of FIG.4A showing the flexible connector in an expanded configuration;

FIG. 5A is a partial cross-sectional view of one embodiment of asurgical access device having a floating sealing element with a surgicalinstrument inserted therethrough;

FIG. 5B is a cross-sectional view of the surgical access device of FIG.5A showing the floating sealing element moved laterally;

FIG. 5C is a cross-sectional view of one embodiment of a floatingsealing element with a flexible membrane for allowing lateral movement;

FIG. 6A is a cross-sectional view of one embodiment of a surgical accessdevice having a bellows connector extending between a retractor and ahousing;

FIG. 6B is a cross-sectional view of the surgical access deviceembodiment of FIG. 6A showing the housing moved laterally relative tothe retractor via the bellows connector;

FIG. 7A is a perspective view of one embodiment of a surgical accessdevice having a plurality of floating seals disposed therein;

FIG. 7B is a cross-sectional view of a floating seal element capable ofangular adjustment via one or more gimbals;

FIG. 8A is a cross-sectional view of one embodiment of a surgical accessdevice having a hinged seal base;

FIG. 8B is a cross-sectional view of the surgical access deviceembodiment of FIG. 8A;

FIG. 8C is a cross-sectional view of the surgical access deviceembodiment of FIG. 8A showing the hinge moved;

FIG. 8D is a top view of the surgical access device embodiment of FIG.8A;

FIG. 9A is a cross-sectional view of another embodiment of a surgicalaccess device having a raised sealing element formed in a seal base;

FIG. 9B is a cross-sectional view of one embodiment of a surgical accessdevice having a sealing element that is flush with a seal base;

FIG. 9C is a cross-sectional view of one embodiment of a surgical accessdevice having a sealing element that is recessed in a seal base;

FIG. 9D is a cross-sectional view of another embodiment of a surgicalaccess device having sealing elements positioned at different levelswithin the seal base;

FIG. 10A is a perspective view of one embodiment of a seal base for asurgical access device having recessed sealing elements disposedtherein;

FIG. 10B is another perspective view of the seal base embodiment of FIG.10A showing recessed channel sealing elements;

FIG. 10C is a cross-sectional view of the seal base embodiment of FIG.10A;

FIG. 10D is another cross-sectional view of the seal base embodiment ofFIG. 10A;

FIG. 11A is a perspective view of one embodiment of a seal base for usewith a surgical access device showing sealing ports having non-circularapertures;

FIG. 11B is a perspective view of one embodiments of a seal base for usewith a surgical access device showing flexible sealing ports;

FIG. 12A is a perspective view of one embodiment of a surgical accessdevice having a flexible seal base with sealing ports formedtherethrough;

FIG. 12B is an exploded view of the surgical access device of FIG. 12A;

FIG. 12C is an exploded view of the surgical access device of FIG. 12Ashowing the flexible seal base in a concave configuration;

FIG. 12D is a cross-sectional view of the surgical access device of FIG.12A showing the flexible seal base in a concave configuration;

FIG. 13A is a perspective view of one embodiment of a surgical accessdevice having an adapter for changing an effective sealing portdiameter;

FIG. 13B is a perspective view of the surgical access device of FIG.13A;

FIG. 14A is a side view of an embodiment of a surgical access device inthe form of a trocar assembly having a rotatable sealing element;

FIG. 14B is a top view of the surgical access device of FIG. 14A showingthe rotatable sealing element;

FIG. 14C is a cross-sectional view of one embodiment of a rotatablesealing element for use in the surgical access device of FIG. 14A;

FIG. 14D is a cross-sectional view of another embodiment of a rotatablesealing element for use in the surgical access device of FIG. 14A;

FIG. 15A is a perspective view of one embodiment of a surgical accessdevice having a shield extending through a retractor;

FIG. 15B is a cross-sectional view of the surgical access device of FIG.15A;

FIG. 15C is a side view of the surgical access device of FIG. 15A;

FIG. 16A is a perspective view of another embodiment of a surgicalaccess device having sealing channels extending from each sealing port;

FIG. 16B is a perspective view of the surgical access device of FIG. 16Aillustrating the flexibility of the seal channels;

FIG. 17A is a top view of one embodiment of a seal base and a protectivecollar for use with a surgical access device;

FIG. 17B is a perspective view of the seal base and the protectivecollar of FIG. 17A;

FIG. 17C is a bottom view of the seal base and the protective collar ofFIG. 17A;

FIG. 17D is a side view of one embodiment of a retractor having a collarproviding access to a recessed opening in a patient's body;

FIG. 18A is a perspective view of one embodiment of a latching mechanismfor use in a surgical access device;

FIG. 18B is an exploded view of the latching mechanism of FIG. 18A;

FIG. 18C is another perspective view of the latching mechanism of FIG.18A;

FIG. 18D is a perspective view of a housing for use in the latchingmechanism of FIG. 18A;

FIG. 18E is a bottom view of the housing and a seal base for use in thelatching mechanism of FIG. 18A;

FIG. 19A is an exploded view of another embodiment of a latchingmechanism for use in a surgical access device;

FIG. 19B is another exploded view of the latching mechanism of FIG. 19A;

FIG. 20A is a perspective view of one embodiment of a surgical accessdevice having a C-clamp securing mechanism;

FIG. 20B is a perspective view of the surgical access device embodimentof FIG. 20A; and

FIG. 20C is a perspective view of the surgical access device embodimentof FIG. 20A.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

The present invention generally provides improved surgical accessdevices that allow multiple surgical instruments to be inserted througha single surgical access device at variable angles of insertion,allowing for ease of manipulation within a patient's body whilemaintaining insufflation. In certain exemplary embodiments, a housing isprovided having multiple access ports or sealing ports for receivingsurgical instruments. Each sealing port can include one or more sealingelements therein for sealing the port and/or forming a seal around asurgical instrument disposed therethrough. The housing can define acentral longitudinal axis, and the sealing ports can each have a centralaxis that is different from each other and different from the centrallongitudinal axis of the housing, thereby allowing a surgeon morecontrol over the insertion of multiple surgical instruments. In someembodiments, the sealing ports and/or the sealing elements are capableof various types of movement, allowing the surgical instruments to beindividually manipulated as needed.

The various surgical access devices can further include a woundprotector, cannula, ring retractor, or other member for forming apathway through tissue (hereinafter generally referred to as aretractor). The retractor can extend from the housing and it can beconfigured to be positioned within an opening in a patient's body. Thesealing ports can each define working channels extending through thehousing and aligned with the retractor. Any and all of the surgicalaccess devices described herein can also include various other features,such as one or more ventilation ports to allow evacuation of smokeduring procedures that utilize cautery and/or one or more insufflationports through which the surgeon can insufflate the abdomen to causepneumoperitenium, as described for example in U.S. Patent ApplicationNo. 2006/0247673 entitled “Multi-port Laparoscopic Access Device” filedNov. 2, 2006 and incorporated herein by reference in its entirety. Theinsufflation port can be any size and can accept a leur lock or aneedle, as will be appreciated by those skilled in the art.

Any and all embodiments of a surgical access device can also include oneor more safety shields positioned through, in, and around any of thecomponents and/or tissue to provide protection against puncture or tearby surgical instruments being inserted through the device. In addition,any and all embodiments of a surgical access device can includeengagement and release mechanisms that allow certain components of thesurgical access device to be removable as needed.

In use, the surgical access devices disclosed herein can be used toprovide access to a patient's body cavity. The retractor can bepositionable within an opening in a patient's body such that a distalportion of the retractor extends into a patient's body cavity and aproximal portion is coupled to a housing positioned adjacent to thepatient's skin on an exterior of the patient's body. A lumen in theretractor can form a pathway through the opening in a patient's body sothat surgical instruments can be inserted from outside the body to aninterior body cavity. The elasticity of the skin of the patient canassist in the retention of the retractor in the body opening or incisionmade in the body. The retractor can be placed in any opening within apatient's body, whether a natural orifice or an opening made by anincision. For example, the retractor can be placed through theumbilicus, endoscopically including, vaginally, percutaneously, etc. Inone embodiment, the retractor can be substantially flexible so that itcan easily be maneuvered into and within tissue as needed. In otherembodiments, the retractor can be rigid or semi-rigid. The retractor canbe formed of any suitable material known in the art, for examplesilicone, urethane, thermoplastic elastomer, and rubber.

Typically, during surgical procedures in a body cavity, such as theabdomen, insufflation is provided through the surgical access device toexpand the body cavity to facilitate the surgical procedure. Thus, inorder to maintain insufflation within the body cavity, most surgicalaccess devices include at least one seal disposed therein to prevent airand/or gas from escaping when surgical instruments are insertedtherethrough. Various sealing elements are known in the art, buttypically the surgical access device can include at least one instrumentseal that forms a seal around an instrument disposed therethrough, butotherwise does not form a seal when no instrument is disposedtherethrough; at least one channel seal or zero-closure seal that sealsthe working channel created by the sealing port when no instrument isdisposed therethrough; or a combination instrument seal and channel sealthat is effective to both form a seal around an instrument disposedtherethrough and to form a seal in the working channel when noinstrument is disposed therethrough. A person skilled in the art willappreciate that various seals known in the art can be used including,for example, duckbill seals, cone seals, flapper valves, gel seals,diaphragm seals, lip seals, iris seals, etc. A person skilled in the artwill also appreciate that any combination of seals can be included inany of the embodiments described herein, whether or not the sealcombination are specifically discussed in the corresponding descriptionof a particular embodiment.

In an exemplary embodiment, as shown in FIGS. 1C and 3C, a sealingelement in the form of an instrument seal can generally have amulti-layer conical seal 2 and a multi-layer protective member 4disposed on a proximal surface 3 of the conical seal 2. The multi-layerconical seal 2 can include a series of overlapping seal segments 8 thatare assembled in a woven arrangement to provide a complete seal body.The seal segments 8 can be stacked on top of one another or woventogether in an overlapping fashion to form the multi-layer seal 2 havinga central opening 6 therein. The seal segments 8 can be made from anynumber of materials known to those skilled in the art, but in anexemplary embodiment the seal segments 8 are formed from an elastomericmaterial. The multi-layer protective member 4 can similarly be formedfrom a series of overlapping segments 10 that are disposed proximal tothe overlapping seal segments 8 and that are configured to protect theseal segments 8 from damage caused by surgical instruments passedthrough the opening 6 in the seal 2. The protective member 4 can also beformed from various materials, but in certain exemplary embodiments theprotective member 4 is formed from a molded thermoplastic polyurethaneelastomer, such as Pellethane™.

The segments 8, 10 that form the seal 2 and the protective member 4 canbe held together using various techniques known in the art. As shown inFIGS. 1C and 3C, the segments 8, 10 can be held together by several ringmembers that mate to engage the segments 8, 10 therebetween. Inparticular, the protective member 4 is engaged between a crown 12 and agasket ring 14, and the seal 2 is engaged between the gasket ring 14 anda retainer ring 16. Pins 18 can be used to mate the ring members 12, 14,16 and to extend through and engage the segments 8, 10 of the seal 2 andthe protective member 4. In some embodiments, an o-ring 20 can bepositioned between the retainer ring 16 and a sealing port housing toensure an air and liquid tight seal between the same.

When fully assembled, the instrument seal can be disposed at variouslocations within the surgical access device. In some embodiments, theinstrument seal can be disposed within sealing ports formed in the sealbase of the surgical access device. In use, an instrument can be passedthrough a center opening of the instrument seal and the seal segmentscan engage and form a seal around an outer surface of the instrument tothereby prevent the passage of fluids and gas through the seal. When noinstrument is disposed therethrough, the center opening will generallynot form a seal in the working channel, however other configurations inwhich a seal is formed when no instrument is disposed therethrough arealso conceivable. Exemplary instrument seal configurations are describedin more detail in U.S. Publication No. 2004/0230161 entitled “TrocarSeal Assembly,” filed on Mar. 31, 2004, and U.S. application Ser. No.10/687,502 entitled “Conical Trocar Seal,” filed on Oct. 15, 2003, whichare hereby incorporated by reference in their entireties.

As noted above, another sealing element that can be used in the surgicalaccess device is the channel or zero-closure seal, an example of whichis shown in more detail in FIG. 1E. As shown, the illustratedzero-closure seal is in the form of a duckbill seal 24. The seal 24 isconfigured to form a seal in a working channel when no instrument isdisposed therethrough to thus prevent the leakage of insufflation gasesdelivered through the surgical access device to the body cavity. Asshown, the duckbill seal 24 can have a generally circular flange 34 witha sidewall 36 extending distally therefrom. The shape of the sidewall 36can vary, but in the illustrated embodiment, the sidewall 36 includesopposed flaps 35 that extend at an angle toward one another in a distaldirection and that come together at a distal end to form a seal face 38.In other embodiments, the opposed flaps 35 can extend toward one anotherwith no angle to form a seal face 38 that is parallel relative to thecircular flange 34. The opposed flaps 35 can be movable relative to oneanother to allow the seal face 38 to move between a closed position, inwhich no instrument is disposed therethrough and the seal face 38 sealsthe working channel of the surgical access device, and an open positionin which an instrument is disposed therethrough. The seal can includevarious other features, as described in more detail in U.S. applicationSer. No. 11/771,263, entitled “Duckbill Seal with Fluid DrainageFeature,” filed on Jun. 29, 2007, which is hereby incorporated byreference in its entirety. In addition, the seal face 38 of the seal 24can be in any nonlinear shape or configuration known in the art, forexample in an S-shaped configuration, as described in more detail inU.S. Pat. No. 5,330,437, entitled “Self Sealing Flexible ElastomericValve and Trocar Assembly for Incorporating Same,” filed Nov. 12, 1993,which is hereby incorporated by reference in its entirety.

In accordance with the present disclosure the general structure of theseals do not generally form part of the present invention. As such, aperson skilled in the art will certainly appreciate that any and allsealing elements and sealing configurations known in the art can be usedwithin the surgical access device embodiments disclosed herein withoutdeparting from the spirit of the invention disclosed.

One particularly important aspect of the embodiments disclosed herein isthat exemplary surgical access devices provide for greatermaneuverability of surgical instruments within a patient whilemaintaining insufflation. In one embodiment, this greatermaneuverability can be provided by having access or sealing portsextending through a seal base of a housing at various angles differentfrom one another and different from a central longitudinal axis of theseal base and the housing. In other embodiments, this greatermaneuverability can be provided by allowing for multi-directionalmovement of the various components of the device to thereby allowmulti-directional movement of the surgical instruments disposed throughthe device. For example, components of the surgical access device thatcan allow for multi-directional movement can include, but are notlimited to, sealing ports, access ports, sealing elements, seal bases,housings, retractors, and various other components that can beassociated with the surgical access device and that will be describedherein. Multi-directional movement as used herein can generally includerotational movement, vertical movement, lateral movement, angularmovement, and any combinations thereof. Thus, any one of the variouscomponents of the surgical access device can generally havemulti-directional movement relative to one or more of the various othercomponents of the surgical access device and/or with respect to apatient's body, thereby allowing a multitude of ways surgicalinstruments can be moved and manipulated relative to and within apatient's body. It will be appreciated by those skilled in the art thatany of the various aspects and features of the surgical access deviceembodiments described herein can be used in and applied to any and allof the various other embodiments, or to various devices known in theart.

In one embodiment shown in FIGS. 1A-1D, a surgical access device 50 isprovided having a plurality of sealing ports 52 extending therethroughat various angular orientations. The surgical access device 50 can havea housing 56 with a seal base 54 that supports the sealing ports 52 anda retractor 58 extending from the housing 56. While any number ofsealing ports 52 can be formed in the seal base 54, in the embodimentshown in FIG. 1A-1D, three sealing ports 52 extend through the surgicalaccess device 50. The sealing ports 52 can have sealing elements 60disposed therein, and the sealing ports 52 can be formed within the sealbase 50 at various angles that are different from one another anddifferent from a central longitudinal axis of the housing 56, as will bediscussed in more detail below. Such a configuration can preventinterference between surgical instruments as they are inserted throughthe sealing ports 52 at various angular orientations, and can facilitateinstrument positioning.

FIG. 1C illustrates the various components of the surgical access device50. As shown, the housing 56 can be a substantially rigid cylindrical orcircular member having outer threads 72 extending around an outercircumference thereof that are configured to threadedly mate with theinner threads 70 of the seal base 54, which forms the proximal portionof the housing 56. A housing o-ring 74, which can be flexible or rigidas needed, can be positioned on a top surface 76 of the housing 56 toform a seat and a seal between the housing 56 and the seal base 54. Inone embodiment, the seal base 54 can be threadedly secured to thehousing 56 via mating of the inner and outer threads 70, 72 such thatthe housing o-ring 74 is secured therebetween. The seal base 54 can havea proximal surface 62 with port openings 64 formed therethrough forreceiving the sealing ports 52 and a circumferential wall 66 extendingdistally from the proximal surface 62. While any attachment or matingmechanism known in the art can be used to mate various components of thesurgical access device 50 together, in the embodiment shown in FIGS.1A-1D, an inner circumference of the port openings 64 can have innerthreads 68 formed thereon to threadedly mate with the sealing ports 52.In addition, an inner circumference of the circumferential wall 66 canhave inner threads 70 formed thereon to threadedly mate with the housing56.

As noted above, the retractor 58 can extend from the housing 56, and inone embodiment, the retractor 58 is a substantially flexible memberhaving a proximal flange 78 and a distal flange 80 with an innerelongate portion 82 extending therebetween. The proximal flange 78 canbe configured to seat a distal rim 84 of the housing 56 and a proximalo-ring 86 can be positioned between the proximal flange 78 and thedistal rim 84 of the housing 56. The distal rim 84 of the housing 56 canbe attached to the proximal flange 78 of the retractor 58 and theproximal o-ring 86 by an adhesive, sealant, or any other attachmentmechanism known in the art. In one embodiment, the proximal flange 78can be mated to the housing 56 by a lip 88 extending proximally from anouter circumference thereof having threads 90 extending around aninterior surface 92 thereof. The threads 90 can be configured tothreadedly mate with the outer threads 72 on the housing 56 and therebysecure the retractor 58 to the housing 56. A distal o-ring 94 canoptionally be positioned within the distal flange 80 of the retractor 58to provide structural support to the retractor within a patient's body.The proximal and distal o-rings 86, 94 can be flexible or substantiallyrigid as needed for use in a particular application.

As noted above, any number of sealing ports 52 can be formed within andextend through the surgical access device 50. In general, each sealingport 52 can include a port housing 96, which can be seated within theport opening 64 in the seal base 54, and the sealing element 60 whichcan be positioned within the port housing 96. The port housing 96 canhave any shape, height, or angular configuration known in the art aswill be described in detail below, but in the embodiment shown in FIGS.1A-1D, the port housing 96 can have a cylindrical shape. A distalsurface 98 of the port housing 96 can be substantially flat such that itis coplanar with the proximal surface 62 of the seal base 54. A proximalsurface 100 of the port housing 96 can likewise be flat, or it canextend at an angle with respect to the proximal surface 62 of the sealbase 54. The angle at which the proximal surface 100 of the port housing96 extends can determine the angular orientation of a longitudinal axis112 of the sealing port 52, as will be discussed below. The distalsurface 98 of the port housing can be mated to the seal base 54 usingvarious mating techniques. As shown in FIG. 1C, the distal surface 98has an extension portion 102 with deflectable members having a flange104 formed around an exterior surface thereof for engaging the opening64 in the seal base 54. The flange 104 can allow the port housing 96 torotate, as will be discussed below. A port o-ring 106 can be placedwithin an aperture 108 extending around the extension portion 102 tofacilitate sealing between the port housing 96 and the seal base 54 whenthe port housing 96 is threadedly mated with the opening in the housing64. An opening 110 can extend through the port housing 96 for receivingthe sealing element 60, for example an instrument seal.

As shown most clearly in FIG. 1D, because of the shape of the porthousing 96, the sealing element 60 is positioned at an angle relative tothe seal base 54 such that a central axis 112 of the sealing element 60,extending through a center portion thereof, is at an angle relative to acentral longitudinal axis 114 of the seal base 54, housing 56, and theretractor 58. This allows a surgical instrument 116 to be inserted atvarying angles as required in a particular procedure. In someembodiments, all of the sealing ports 52 can be configured to havecentral axes 112 different from each other. In other embodiments, two ormore sealing ports 52 can have a central axis 112 that is the samerelative to each other and different relative to a third, fourth, etc.sealing port 52.

As indicated above, in some embodiments the sealing ports 52 can berotatable relative to the seal base 54. Rotation of the angled sealingports 52 allows the axis 112 and thus the insertion angle provided bythe sealing port 52 to be changed and adjusted. In this way, the sealingport 52 can be rotated prior to or after insertion of a surgicalinstrument therethrough to provide more space around an opening formanipulating the instrument and/or to enable better maneuverability ofthe instrument relative to tissue and to other instruments insertedthrough the access device.

In some embodiments, two or more sealing ports 52 can be positioned on asingle rotatable stage 118, as shown in FIGS. 2A and 2B. The rotatablestage 118 can be a circular body that is rotatably disposed within acircular opening formed in the seal base 54. Various mating techniques,such as the extension with deflectable portions having a flangetherearound as described above, can be used to allow rotation of thestage 118 within the opening in the seal base 54. In use, the stage 118can allow the sealing ports 52 to be moved from a triangularconfiguration as shown in FIG. 2A, to an in-line configuration as shownin FIG. 2B, as well as any position therebetween. Rotating multiplesealing ports 52 at once can allow better maneuverability around thesurgical access device 50 and/or can allow for repositioning of thesurgical instruments while they are inserted within individual sealingports 52. As will be appreciated by those skilled in the art, any numberof sealing ports 52 can be formed in individual rotatable stages 118 onthe seal base 54 to allow rotation of groups of sealing ports 52relative to other sealing ports 52, the seal base 54, and/or the housing56.

In other embodiments, the sealing ports 52 can be vertically, laterally,and angularly adjustable relative to the seal base 54 by forming atleast a portion of the port housing 96 from a flexible connector, forexample, a bellows. A flexible connector or bellows can allow thesealing element 60 positioned within the port housing 96 to be movedvertically, laterally, rotationally, and angularly as needed to adjustan insertion angle of a surgical instrument or a position of a surgicalinstrument within a body cavity.

In some embodiments, a connector 120 can be positioned between thehousing 56 and the retractor 58, as shown in FIGS. 3A-3D. The connector120 can generally be an element that allows movement of the housing 56and the seal base 54 relative to the retractor 58. For example, theconnector 120 can be a substantially flexible elongate portion and/or abellows that allows the housing 56, and thereby the seal base 54 and thesealing ports 52, to have a full range of motion relative to theretractor 58. In one embodiment, the connector 120 can have a connectorbase 122 that seats the connector 120 and allows it to be mated with theproximal flange 78 of the retractor 58. A proximal portion 124 of theconnector 120 can mate with the distal rim 84 of the housing 56 via anymating mechanism known in the art including, but not limited to,adhesive, sealant, threads, etc. In the same way, the connector base 122and the connector 120 can be joined by any mating mechanism known in theart. In addition the connector base 122 can be threadedly or rotatablymated with the lip 88 of the retractor 58.

In another embodiment shown in FIGS. 4A and 4B, a latch, living hinge,or clip 124 can be used to secure a portion of the connector 120 againstmovement, thereby allowing easier angular adjustment of the housing 56and the seal base 54 relative to the retractor 58. As shown, the clip124 can secure one side of the housing 56 to a corresponding side of theretractor 58, thereby allowing an opposing portion of the connector 120to expand as it pivots about the connected point. In some embodiments,the connector 120 can be more flexible than the retractor 58 to ensurethe retractor 58 remains secured within an opening in the body as theconnector 120 is expanded and moved. As shown in FIG. 4B, any movement,whether vertical, lateral, rotational, or angular, allows the insertionangle and/or the position of the sealing ports 52 to be changed andadjusted relative to the retractor 58.

In other embodiments such as those shown in FIGS. 5A-5C, a surgicalaccess device 150 is provided having sealing ports 152 that aresubstantially parallel with a seal base 154. The sealing ports 152 caneach have a port housing 158 that has a diameter larger than a diameterof a sealing element 156 disposed therein. The sealing element 156 canbe positioned within the port housing 158 such that the sealing element156 is movable within the larger diameter of the port housing 156. Inone embodiment, shown most clearly in FIG. 5C, the sealing element 156can be attached to a bellows-like structure or flexible membrane 164that can stretch and bunch to allow the sealing element 156 to movelaterally within the port housing 158. The sealing element 156 can thusbe floating laterally relative to the port housing 158 and can move inmultiple directions within a plane parallel to the seal base 154. Such aconfiguration allows a smaller incision through the body through whichthe retractor 162 extends, by allowing the sealing element 156 to moverelative to the retractor 162 as needed. Exemplary movable and floatingseal configurations are described in more detail in the followingpublications, all of which are incorporated herein by reference: U.S.Publication No. 2005\0070946, entitled “Reinforced Seal Assembly,” filedon Sep. 17, 2004; U.S. Publication No. 2007/0255218, entitled “PleatedTrocar Seal,” filed on Apr. 18, 2006; U.S. Pat. No. 5,385,553, entitled“Trocar with Floating Septum Seal,” filed on Jun. 15, 1993; and U.S.Pat. No. 5,496,280, entitled “Trocar Valve Assembly,” filed on May 19,1994.

The embodiments shown in FIGS. 5A and 5B can include a connector 151, aspreviously described with respect to FIGS. 3A and 3B, and as shown inFIGS. 6A and 6B. Such a configuration allows the housing 160 and theseal base 154 to be moved vertically via the connector 151 relative tothe retractor 162 to change a height of the sealing ports 152 relativeto the retractor 162. The housing 160 and the seal base 154 can also bemoved laterally via the connector 151 to translate a position of thesealing ports 152 relative to the retractor 162, as shown, for example,in FIGS. 6A and 6B. As shown, the connector 151 can allow the sealingports 152 to be moved laterally into alignment with the retractor 162for easier insertion of surgical instruments. The housing 160 canfurther have limited rotational movement via the connector 151 to changethe rotational position of the sealing ports 152. As will be appreciatedby those skilled in the art, the housing can have any combination ofvertical, lateral, and rotational movement via the connector 151 asneeded in a particular application.

In another embodiment shown in FIGS. 7A and 7B, the surgical accessdevice 170 can include a rotatable sealing port 172 that is rotatablyseated in a port 180 formed in a seal base 174. The sealing port 172 canhave one or more gimbal mechanisms 176 to allow a sealing element 178 tochange its angular orientation with the port housing 180. The gimbalmechanism 176 can be, for example, a generally spherical member withflattened top and bottom portions and an opening extending therebetweenwith a seal element 177 extending thereacross. As shown, the gimbal 176,and the sealing element 178 can polyaxially rotate within the porthousing 180 such that it is capable of multidirectional angulardisplacement. As shown in FIG. 7B, pivotal movement of the gimbal 176and thus the sealing element 178 is effective to change the centrallongitudinal axis of the sealing element 178, allowing greatermaneuverability for an instrument inserted therethrough.

In still another embodiment shown in FIGS. 8A-8D, a surgical accessdevice 200 is provided having a housing 202 with a hinged seal base 204.One or more sealing ports 206 can extend through the hinged seal base204 and can be configured to receive surgical instruments therethrough.The hinged seal base 204 can be selectively movable between variousangular configurations relative to a top opening 208 of the housing 202via a hinge 210 positioned within the seal base 204. The hinge can belocated anywhere on the seal base 204, and any number of ports can bepositioned in one or both sides of the hinge to allow angular adjustmentof the ports. In lower profile configurations, the sealing ports 206 canhave a central axis 212 that is substantially parallel to the centralaxis of the top opening 208 of the housing 202. The sealing ports 206can be moved into higher profile configurations, such as that shown inFIGS. 8A-8C, in which the central axis 212 of the sealing ports 206forms an angle relative to the central axis of the opening 208 in thehousing 202. In this way, the angular orientation of the sealing ports206 can be changed and adjusted by simply changing the position of thehinged seal base 204. It will be appreciated that the hinged seal base204 can be locked or maintained at any position between the low profileconfiguration and high profile configurations as needed. A latch,switch, or other locking mechanism known in the art can be used.

In some embodiments, as will be appreciated by those skilled in the art,any number of sealing ports 206 can be disposed in each section 216 a,216 b of the hinged seal base 204. In addition, there can be one or morehinges 204 formed in the seal base 204 to allow for multiple movablesurfaces. In one embodiment, a flexible membrane or other stretchableand/or flexible material can be used to connect the hinged seal base 204with the housing 202 to ensure that a gas and liquid tight seal ismaintained while allowing the hinged seal base 204 to move between lowand high profile configurations. A person skilled in the art willappreciate the various other techniques can be used to allow the hingedseal base 204 to move relative to the housing 202 while maintaining aseal therebetween.

Any and all of the access ports, sealing ports, and/or sealing elementsdescribed herein can also be positioned at various vertical orientationswithin a seal base and housing of a surgical access device. For example,as shown in FIG. 9A, a raised sealing port 220 is positioned above aseal base 222 such that a surgical instrument inserted therethrough willtravel through a sealing element 224 before traveling through the sealbase 222 and entering a housing 226. In another embodiment shown in FIG.9B, a sealing port 228 is flush or parallel with the a seal base 232such that a surgical instrument inserted therethrough enters a sealingelement 230 concurrently with entering the seal base 232. In a furtherembodiment shown in FIG. 9C, a sealing port 236 can be in a recessedposition below a proximal surface 238 of a seal base 240. Angled guides242 can direct a surgical instrument into the recessed sealing port 236to facilitate accurate insertion of the instrument.

In addition, as shown in FIG. 9D, multiple sealing ports 244 a, 244 b,244 c can also be configured at various heights relative to a seal base246. For example, the proximal surface of sealing ports 244 a and 244 b,as well as the sealing elements disposed therein, can be positionedsubstantially co-planar with one another at the same height relative tothe seal base 246, while the proximal surface of sealing port 244 c, aswell as the sealing element therein, is positioned lower than sealingports 244 a and 244 b. Using sealing ports and sealing elements that areof different heights and/or are off-plane from each other can allow forthe longitudinal axis of the sealing port, and subsequently theinstrumentation used, to be closer together, thereby allowing for asmaller incision or use in a smaller opening in tissue. In oneembodiment, the off-plane sealing ports can allow for the use of largersealing ports and/or sealing elements within the same space byoverlapping the edges of the sealing ports and/or sealing elementsbecause they can be on different planes. In addition, during retractionof target tissue, the off-plane sealing ports can provide for customangles depending on the instrumentation intended to be used with thesealing port. In other embodiments, instead of being off-plane, any oneor all of the sealing ports can have flattened side walls to enable thesealing ports to be positioned closer together within the seal base. Aswill be appreciated by those skilled in the art, exemplary surgicalaccess devices can have seal ports at any number of verticalorientations, including all sealing ports being at a different verticalheights. In addition, any number of the sealing ports can be spaced andpositioned laterally within a seal base in any configuration as needed.The sealing ports can also extend in a plane transverse to a plane ofthe base, as previously discussed.

In another exemplary embodiment shown in FIGS. 10A-10D, a proximalportion 250 of a surgical access device is provided having acylindrically shaped seal base 252 mated with a housing 266 and havingthree recessed access or sealing ports 254 a, 254 b, and 254 c extendingtherethrough. Two of the sealing ports 242 a, 254 b can have a firstdiameter D1, and the third sealing port 254 c can have a second diameterD2, which can be larger than the first diameter D1. In certain exemplaryembodiments, the first diameter D1 is about 3 mm and the second diameterD2 is about 5 mm. A person skilled in the art will appreciate that therecan be any number of sealing ports disposed within the seal base 252 andthe sealing ports can have any combination of diameters as needed. Asshown, the sealing ports 254 a, 254 b, 254 c can be recessed into theseal base 252 so that a proximal surface 256 of the seal base 252 issubstantially flat. Guides 258 can direct a surgical instrument intosealing elements, for example into an instrument seal 260 and a channelseal 262, disposed within the sealing ports 254 a, 254 b, 254 c.

The seal base 252 and/or the housing 266 can have a height H toaccommodate a full length of the channel seals 262 to prevent channelseal openings 264 from coming into contact with a retractor (not shown)extending from the housing 266. This configuration can prevent retractorsidewalls from contacting the channel seal openings 264 and causing themto open when the seal base 252 and the housing 266 is moved relative tothe retractor. In other embodiments, the seal base 252 and the housing266 can have a total height H less than a longitudinal length of thechannel seals 262. In such a configuration, each channel seal opening264 can be oriented to minimize contact with the retractor. For example,each seal opening 264 can be aligned tangential to a circumference ofthe seal base 252, the housing 266, and a retractor extending from thehousing 266 as shown in FIG. 10B. In other words, the opening can extendin a direction that is substantially parallel to a circumference of thehousing 266, and not transverse to the housing 266. Such an alignmentcan prevent the channel seal opening 264 from being pushed open by aretractor sidewall when the seal base 252 and the housing 266 is movedrelative to the retractor. A person skilled in the art will appreciatethat, while duckbill seals are shown, any sealing elements known in theart can be aligned in such a way, including non-linear sealing elements,for example sealing elements with an S-shaped opening.

In another embodiment shown in FIG. 11A, a seal base 270 is providedhaving a plurality of access or sealing ports 272 extendingtherethrough. One or more of the sealing ports 272 can have a porthousing 274 and/or a sealing element 276 with a non-circular shapedopening to receive a surgical instrument 278 having a non-circularcross-section. The non-circular shaped sealing ports 272 can have anyshape known in the art, including but not limited to oval, triangular,quadrilaterals, polygons, etc. Each port housing 274 and/or sealingelement 276 can be rotatable relative to the seal base 270 so that asthe non-circular shaft of a surgical instrument 278 is insertedtherethrough, the sealing port 272 can rotate to orient itself inalignment with the cross-sectional shape of the surgical instrument 278.In one embodiment, the sealing ports 272 can be attached to the sealbase 270 using a bellows connector or other flexible member 280 to allowthe sealing port 272 to move vertically and/or laterally with respect tothe seal base 270.

In another embodiment shown in FIG. 11B, a seal base 282 is providedhaving a plurality of sealing ports 284 extending therethrough. Each ofthe sealing ports 284 can have sealing elements 286 disposed therein.The sealing ports 284 can have a port housing 283 that is flexible toallow the port housing 283 to move vertically, laterally, and angularlyrelative to the seal base 282. In some embodiments, at least a portionof the sealing ports 284 and/or the port housing 283 can be corrugatedand/or can be formed of a bellows or other flexible material or flexiblemechanism. Each of the sealing ports 284 can also have a releasemechanism, such as a C-clamp 288, that allows the sealing element 286 orother component of the sealing port 284 to be removed to allow specimensor other objects to be therethrough. The port housings 283 can also varyin height as shown. A person skilled in the art will appreciate thevarious flexible portions that can be used to allow the port housing 286to move relative to the seal base 282.

In another embodiment shown in FIGS. 12A-12D, a surgical access device300 is provided having a flexible seal base 302 and a housing 304. Theflexible seal base 302 can have one or more access or sealing ports 306formed therethrough for receiving a surgical instrument. The flexibleseal base 302 can have any shape, but in the illustrated embodiment isgenerally dome shaped with a flange 308 extending around a distalcircumference thereof that is configured to mate with the housing 304 aswill be described below. As a result, the flexible seal base 302 has aconcave configuration, in which it extends proximally from the housing304, as shown in FIGS. 12A and 12B, and a convex configuration in whichit extends distally into the housing 304, as shown in FIGS. 12C and 12D.The flexible seal base 302 can be selectively moved between the convexand concave configurations as needed to reorient one or more of thesealing ports 306.

The sealing ports 306 can be formed or disposed in the flexible base 302using various techniques. In the illustrated embodiment, each seal port306 is in the form of a rigid ring-shaped member that supports thesealing element 303, which can likewise include a rigid ring-shapedstructure 305. The ring 305 around the seal elements 303 can be fixedlyor movably seated within the rigid ring 305 that forms the seal port 306in the flexible base 302.

In one embodiment, when the flexible seal base 302 is in the convexconfiguration, the sealing ports 306 can have first central axes 310such that a surgical instrument is inserted at a specified angle ororientation. When the flexible seal base 302 is moved toward or into theconcave configuration, the sealing ports 306 can transition toward orinto to second central axes 312 such that a surgical instrument isinserted at a different angle or orientation than in the convexconfiguration. When the flexible seal base 302 is in the convexconfiguration, the central axes of the sealing ports 306 are generallyoriented in a distal direction toward a center of the flexible seal base302 and the housing 304. When the flexible seal base 302 is moved into aconcave configuration, the central axes of the sealing ports 306 can begenerally directed in a distal direction outward from the center of theflexible seal base 302 and housing 304. As shown, the sealing ports 306can be generally situated proximally to the housing 304 when theflexible seal base 302 is in the convex configuration. In the concaveconfiguration, the sealing ports 306 can generally extend into thehousing 304.

In one embodiment, the housing 304 that supports the base 302 can besubstantially rigid, although it will be appreciated that it can beflexible as needed in a specific application, and it can be generallycylindrical or tubular in shape. The housing 304 can have an outercomponent 314 and an inner component 316 concentrically positioned andnested together. The flange 308 of the flexible seal base 302 can bepositioned on a proximal rim 318 of the inner component 316 and orientedsuch that holes 320 formed in the flange 308 are aligned withcorresponding holes 322 formed in the proximal rim 318. The outercomponent 314 can have a flange 324 on a proximal most rim 326 thatextends toward a center of the outer component 314. The flange 324 canhave posts 328 extending distally therefrom configured to mate theflexible seal base 302 and the inner component 316. The outer component314 can be positioned over and around the inner component 316 andoriented such that the posts 328 will engage and extend through thealigned holes 320, 322 of the flexible seal base flange 308 and theinner component rim 318. In this way, the outer component 314 can securethe flexible seal base flange 308 between the two concentric components314, 316. A person skilled in the art will appreciate the variety ofother mating and securing mechanisms can be used to secure the rim ofthe flexible seal base 302 to the housing 304.

In one embodiment, a distal portion 330 of the inner component 316 ofthe housing 304 can have threads 332 formed around an exterior thereoffor mating with a retractor 334. An o-ring 336 can be positioned betweenthe distal portion 330 of the inner component 316 and a proximal flange338 of the retractor 334 to ensure a gas and liquid tight seal betweenthe two. The proximal flange 338 of the retractor 334 can have acircumferential lip 340 extending proximally that can have threads 342extending around an interior circumference thereof. The distal threadedportion 330 of the inner component 316 can be threaded into the lip 340of the retractor 334, thereby securing the housing 302 with theretractor 334.

In other exemplary embodiments, any and all of the surgical accessdevice embodiments discussed herein, as well as in any combinationsthereof, can have an adapter removably matable to at least one of thesealing ports to change a size, shape, or orientation of the sealingport without loss of pneumoperitoneum. In one embodiment, shown in FIGS.13A and 13B, the adapter 350 can be rotatably or pivotably attached to aportion of a seal base 352, and it can be selectively positionableadjacent to a sealing port 354 to change a feature of the sealing port354. In particular, in the embodiment shown in FIGS. 13A and 13B, theadapter 350 is a sizing adapter to change an effective diameter of thesealing port 354 disposed within the seal base 352. The adapter 350 canbe pivotably attached to a portion of an outer circumference 356 of theseal base 350 such that it can move between open and closedconfigurations. In an open configuration, the adapter 350 can bepositioned away from an opening of the sealing port 354, as shown inFIG. 13A. In the closed configuration, the adapter 350 can be pivoted orrotated via a hinge 358 such that it is positioned over an opening 360of the sealing port 354 to thereby change an effective diameter of thesealing port 354. For example, in the open configuration, the sealingport 354 can receive a surgical instrument having a 12 mm diameter. Inthe closed configuration, the adapter 350 can allow the sealing port 354to receive a surgical instrument with a 5 mm diameter. A person skill inthe art will appreciate that any size adjustments can be made with suchan adapter 350 as needed.

In other embodiments, an adapter can change an effective shape of asealing port. For example, the sealing port can have a circular shape toreceive an instrument with a circular cross-section when the adapter isin an open configuration. In the closed configuration, the adapter canallow the sealing port to receive a surgical instrument having anon-circular cross-section such as a triangle, oval, quadrilaterals,and/or other polygons. In addition, the adapter can also allow aneffective orientation change of a sealing port. As will be appreciatedby those skilled in the art, a shape and size change can be combinedinto a single adapter as needed.

As will also be appreciated by those skilled in the art, any and all ofthe seal base and housing embodiments disclosed herein can beinterchangeable with one another as needed. For example, a kit couldinclude multiple housings and seal bases with one or more retractors.Each seal base and housing combination can have different sized, shaped,and/or angled sealing ports extending therethrough so that a surgeon canactively change housings and seal bases as needed. A release mechanism,such as those described in detail below, can be used to releasablyattach the various seal bases and housings to a retractor.

A person skilled in the art will also appreciate that the variousfeatures disclosed herein can likewise be incorporated into a singleport access device. FIGS. 14A-14D illustrate another embodiment of asurgical access device in the form of a trocar assembly 370 having ahousing 372 and a flexible cannula 374 extending therefrom. The housing372 can have a sealing element 376 disposed therein that is rotatablewith respect to the housing 372 to allow rotation and adjustment of adevice inserted within the sealing element 376 without requiringrotation of the trocar housing 372 and the flexible cannula 374. Forexample, if an endoscope is inserted through the trocar assembly 370,the sealing element 376 can rotate with the endoscope and independentlyof the housing 372 and the flexible cannula 374 to allow adjustment inwhat is being viewed by the endoscope.

In one embodiment shown in FIG. 14C, a rotatable seal 371 is providedhaving an annular disc 373 positioned within an elastic outer ring 375.The annular disc 373 can be flexible or rigid and a sealing element 388can be disposed therein with an opening 389 formed therethrough forreceiving a surgical instrument. The annular disc 373 can be mated tothe elastic outer ring 375 by any mating mechanism known in the art,such as a flange extending between the annular disc 373 and the outerring 375. The elastic outer ring 375 can be positioned within a grooveformed in the housing 372 of the trocar assembly 370, thereby allowingthe rotatable seal 371 to rotate relative to the housing whilemaintaining a seal around a surgical instrument inserted therethrough.

In another embodiment shown in FIG. 14D, a rotatable seal 380 isprovided having an annular disc 382 that can be positioned within thehousing 372 of the trocar assembly 370. The annular disc can have asealing element 390 positioned therein with an opening 391 formedtherethrough for receiving a surgical instrument. The annular disc 382can have a top o-ring 384 and a bottom o-ring 386 disposed on top andbottom surfaces 385, 387 thereof for forming a seal between the annulardisc 382 and the housing 372. The annular disc 382 can rotate relativeto the housing 372, while the o-rings 384, 386 maintain a sealtherebetween. A person skilled in the art will appreciate that a varietyof mechanisms can be used to create a rotatable seal within the housing372 of the trocar assembly 370.

The trocar assembly 370 can include other features as well, such as acable or other steering mechanism to provide steering control over theflexible cannula 374. In this case, the flexible cannula 374 and theinstrument inserted within the sealing element 376 through the flexiblecannula 374 can be independently movable and controllable as needed.

As surgical instruments are inserted through the surgical access deviceembodiments described herein, a risk can exist that a particularly sharpinstrument may tear or puncture a portion of the retractor or nearbytissue. Accordingly, in any and all of the embodiments described herein,a safety shield can optionally be included to reduce the risk of tearingor puncture by a surgical instrument. In general the shield can be of amaterial that is relatively smooth to allow ease of passage ofinstruments, but resistant to tearing and puncture. For example, theshield can formed of silicone, urethane, thermoplastic elastomer,rubber, polyolefins, polyesters, nylons, fluoropolymers, and any othersuitable materials known in the art. The shield can generally provide aliner for a retractor or tissue and can be detachable from a surgicalaccess device so it can be used as needed in a particular procedure.

In one exemplary embodiment shown in FIGS. 15A-15C, a surgical accessdevice 400 is provided having a seal base 402 with a plurality ofsealing ports 404 extending therethrough. The surgical access device 400can also include a shield 406 and a retractor 408. As shown, the shield406 can extend through the retractor 408 to thereby provide a protectivelining as surgical instruments are inserted through the device. Theshield 406 can have a length corresponding to a length of the retractor408, but can also have a length considerably longer than the length ofthe retractor depending on a specific application. The retractor 408 andthe shield 406 can be mated to a housing 410. For example, the retractor408 can have a proximal flange 414 that can be mated to a distal portion412 of the housing 410. Any mating mechanism known in the art can beused, for example, adhesive, screws, press fit, etc. The shield 406 canhave a proximal flange 416 that can be seated within an aperture 418formed in a proximal portion 420 of the housing 410. The housing 410 canhave a latch 422 that can facilitate selective attachment of the sealbase 402 to the housing 410. When engaged, the latch 422 can secure theseal base 402 to the housing 410 such that the proximal flange 416 ofthe shield 406 is secured within the aperture 418 formed in the housing410. When disengaged, the seal base 402 can be removed such that theshield 406 can be removed or adjusted as needed. In some embodiments,steering cables or another controlling mechanism known in the art can beused to control a position of the shield 406 and can be used to steerthe shield 406 as needed along a tortuous pathway.

In another embodiment, as shown in FIGS. 16A and 16B, each sealing port450, a housing 460, a retractor 462, or the various devices disclosedherein can have a flexible elongate seal channel extending distallytherefrom. The seal channel 454 can be removably attached to a closeddistal surface of the retractor, or it can be directly coupled to asealing element 458 and can extend through the seal base 452, thehousing 460, the retractor 462, and beyond as needed. As shown in FIG.16B, the seal channels 454 can be flexible such that the channels movewith and maintain a seal around a surgical instrument insertedtherethrough. A distal-most portion 462 of the sealing channel 454 canhave sealing flaps 464 that can form a seal around a surgical instrumentinserted therethrough that can remain closed when no instrument isinserted therethough. Other exemplary embodiments of flexible sealchannels are disclosed in U.S. application Ser. No. [ ] entitled“Surgical Access Device with Flexible Seal Channel” [Atty. Docket No.100873-315(END6487USNP)] and filed on even date herewith, which ishereby incorporated by reference in its entirety.

In another embodiment shown in FIGS. 17A-17C, a seal base 430 isprovided having a collar or shield 432 extending proximally therefrom.The shield 432 can be configured to protect tissue as instruments areinserted into sealing ports 434. For example, a surgical access devicecould be inserted into an opening within a body that leaves tissuesituated proximally of the seal base 430 exposed to punctures or tearsby insertion of surgical instruments. Accordingly, the shield 432 can beattached to the seal base 430 and extend therefrom to provide protectionto surrounding tissue.

The shield 432 can be attached to the seal base 430 by any attachmentmechanism known in the art, and in one embodiment, the shield 432 can beconnected to the seal base 430 using cantilevered snap tabs such thatthe shield is selectively removable as needed. The snaps and at least adistal portion 436 of the shield 432 can be substantially rigid toprovide stability to the surgical access device. Any suitable materialcan be used to form the distal portion including, but not limited topolycarbonate or high density polyethylene. A proximal portion 438 ofthe shield 432 can be substantially flexible to allow maneuverability ofthe shield relative to tissue and can be formed of any suitable materialknown in the art including, but not limited to, silicone, urethane,thermoplastic elastomer, and rubber. In some embodiments, the shield 432can have sufficient rigidity to allow it to be used to rotate the sealbase 430 relative to a housing and/or a housing to rotate relative to aretractor.

In some embodiments, the shield 432 can have a series of apertures oropenings 440 formed around a circumference of the proximal portion 438.The openings 440 can allow the shield 432 to be secured to a patientusing sutures or other mechanisms and/or to secure a modesty coveringfor a patient. In addition, stability features, for example ridges orgrooves, can be located on a tissue contacting surface of the shield 432to prevent rotation of the shield 432 once inserted into a patient. Aperson skilled in the art will appreciate that various shapes and typesof shields, both rigid and flexible, can be used in various positionswithin a surgical access device to protect various components and/ortissue.

In another embodiment, the shield can extend between the housing and theretractor, and it can vary in shape. For example, FIG. 17D illustrates asurgical access device 480 having a housing 482 with a variety ofsealing ports 484 formed therethrough. The housing 482 has an extendedretractor 486 formed from a conically shaped collar 488 and a flexibleelongate portion 490. A proximal portion 492 of the collar 488 can befixedly or movably mated with a distal portion 494 of the housing 482 byany mating mechanism known in the art, for example, adhesive, press fit,etc. The collar 488 can be flexible or rigid and can have any length asneeded to provide a working channel to a recessed opening 496 in apatient's body such that the flexible elongate portion 490 can bepositioned therein. The flexible elongate portion 490 can extend throughthe collar 488, or it can be formed on or mated to a distal end 498 ofthe collar 488 and can extend distally therefrom. In some embodiments,the flexible elongate portion 490 can have a portion that extends pastthe wall of the vagina and further into the abdomen, either with orwithout a distal ring. As shown, the collar 488 can have a diameter thatdecreases distally to provide a particular fit within an opening and/oralong a specific pathway into the body. In some embodiments, the collar488 can have openings formed therein to allow tissue to invaginate intothe collar 488 to retain the flexible elongate portion 490. It will beappreciated by those skilled in the art that the collar 488 can have anyshape or angular orientation as needed to provide access to a recessedopening in a patient's body. In this way, the flexible elongate portion490 can function to hold open the recessed opening 496 while the collar488 provides a pathway from the housing 482 to the flexible elongateportion 490 such that surgical instruments can be inserted therethroughfor various procedures within a patient's body.

In any and all of the surgical access device embodiments disclosedherein, an engagement and/or release mechanism can be included to allowa seal base to be separated from a housing, to allow a housing to beseparated from a retractor, and/or to allow a seal port to be separatefrom a seal base. In one embodiment shown in FIGS. 18A-18F, a surgicalaccess device 500 is provided and can include a seal cap 514 havingopenings 506 formed therein and a seal base 502 with one or more sealingports 504 in communication with the openings 506 of the seal cap 514.The sealing ports 504 can have one or more sealing elements 512 therein.A housing 508 can seat and support the seal cap 514 and the seal base502, and a retractor 510 can be mated with the housing 508 and can beconfigured to be positioned within an opening in a patient's body.

As shown, the seal cap 514 and the housing 508 can include an engagementand release mechanism in the form of a latch mechanism 516 that enablesthe seal cap 514 to be removable from the housing 508. Two tabs 518 canextend from opposite sides of a distal portion 520 of the seal cap 514and can be configured to engage corresponding slots 522 formed in aninner ring 524 of the housing 508. A latch ring 526 can be positionedbetween the inner ring 524 and an outer circumference of the housing 508and can have a latch 528 formed thereon. The latch 528 can extendoutward from the latch ring 526 through a window 530 in the outercircumference of the housing 508 and can be moved laterally back andforth a short distance within the window 530, as will be described inmore detail below.

The inner ring 524 can include a spring slot 532 for receiving a spring534 therein. One end 536 of the spring 534 can be in contact with aprotrusion 538 of the latch ring 526. An opposing end 540 of the spring534 can be in contact with the spring slot 532 of the inner ring 524. Inthis way, as the latch 528 is moved within the window 530, the entirelatch ring 526 moves, thereby causing the spring to be compressedbetween the protrusion 538 and one end of the spring slot 532.Accordingly, the latch 528 is biased to a position in which the spring534 is uncompressed, as shown in FIG. 18D.

As the tabs 518 on the seal cap 514 are inserted into the slots 522 inthe housing 508, the tabs 518 can engage camming elements 536 andthereby cause the latch 528 to move laterally within the window 530 asthe latch ring 526 is moved relative to the outer circumference of thehousing 508 and the inner ring 524. Once the tabs 518 are inserted pastledges 538 formed on the tabs 518, the spring 534 can cause cammingelements 536, and correspondingly the latch 528, to travel back to theirbiased position shown in FIG. 18D, thereby securing the seal cap 514 tothe housing 508. To release the seal cap 514 from the housing 508, thelatch 528 can be moved laterally within the window 530 to cause theprotrusion 538 in the latch ring 526 to compress the spring 534. Thisaction can move the camming element 536 out of the way of the tabs 518,thereby allowing the seal cap 514 to be disengaged and withdrawn fromthe housing 508. In this way the latch mechanism 516 can allow forrepeated engagement and disengagement of seal caps and seal bases from ahousing and retractor as needed.

In another embodiment shown in FIGS. 19A and 19B, a proximal portion 600of a surgical access device is provided and can include a seal cap 614having openings 606 formed therein and a seal base 602 with one or moresealing ports 604 in communication with the openings 606 of the seal cap614. The sealing ports 604 can have one or more sealing elements 612therein. A housing 608 can seat and support the seal cap 614 and theseal base 602, and a retractor (not shown) can be mated with the housing608 and can be configured to be positioned within an opening in apatient's body. An o-ring 626 can be positioned between the seal cap 614and the housing 608 to ensure an air and liquid tight seal therebetween.

As shown, the seal cap 614 and the housing 608 can include an engagementand release mechanism in the form of a bayonet latch mechanism. Twobayonet feet 618 can extend from opposite sides of a distal portion 620of the seal cap 614 and can be configured to engage corresponding slots622 formed in an inner ring 624 of the housing 608. The bayonet feet 618on the seal cap 614 can be lowered into the slots 614 in the inner ring624 of the housing 608. The seal cap 614 can be rotated, for example ina clockwise direction, relative to the housing 608, thereby causing thebayonet feet 618 to travel laterally within the slots 622 to a positionin which ledges 628 cover corresponding ledges 630 on the bayonet feet618, thereby securing or locking the seal cap 614 to the housing 608. Ifdisengagement is desired, the seal cap 614 can be rotated, for examplein a counter clockwise direction, such that the bayonet feet 618 arefree to be withdrawn from the slots 614.

In a further embodiment shown in FIGS. 20A-20C, a surgical access device650 is provided having a dome-shaped seal base 652 with a plurality ofseal ports 654 extending therethrough. The seal base 652 can bepositioned adjacent to a housing 656 and secured thereto by a C-clamp658. A first retractor 660 can be mated with the housing 656 by anymethod known in the art and a second retractor 662 can be mated with thefirst retractor 660 as shown.

The C-clamp 658 can be a substantially rigid element that is in theshape of a “C” and can have a tab 664 formed integrally therewith. Thetab 664 can have a series of ridges 666 or other surface formations thatallow for an easy and secure grip during attachment and removal of theC-clamp 658. The C-clamp 658 can be positioned around a proximal rim 668of the housing 656 and a distal rim 670 of the seal base 652 to therebysecure the two together. The C-clamp 658 provides a press-fit around therims 668, 670. The C-clamp 658 can be removed from around the two rims668, 670 to allow detachment of the seal base 652 from the housing 656.A person skilled in the art will appreciate that a variety of clamps canbe used to secure various components of the surgical access devicestogether as needed.

There are various features that can optionally be included with any andall of the surgical access device embodiments disclosed herein. Forexample, a component of the device, such as a seal base, housing,retractor, etc., can have one or more lights formed thereon or around acircumference thereof to enable better visualization when insertedwithin a patient. As will be appreciated, any wavelength of light can beused for various applications, whether visible or invisible. Any numberof ports can also be included on and/or through the surgical accessdevices to enable the use of various surgical techniques and devices asneeded in a particular procedure. For example, openings and ports canallow for the introduction of pressurized gases, vacuum systems, energysources such as radiofrequency and ultrasound, irrigation, imaging, etc.As will be appreciated by those skilled in the art, any of thesetechniques and devices can be removably attachable to the surgicalaccess device and can be exchanged and manipulated as needed.

The embodiments described herein can be used in any known and futuresurgical procedures and methods, as will be appreciated by those skilledin the art. For example, any of the embodiments described herein can beused in performing a sleeve gastrectomy and/or a gastroplasty, asdescribed in U.S. application Ser. No. [ ] entitled “Methods and Devicesfor Performing Gastrectomies and Gastroplasties” [Atty. Docket No.100873-317(END6488USNP)] and filed on even date herewith, U.S.application Ser. No. [ ] entitled “Methods and Devices for PerformingGastrectomies and Gastroplasties” [Atty. Docket No.100873-318(END6488USNP1)] and filed on even date herewith, and U.S.application Ser. No. [ ] entitled “Methods and Devices for PerformingGastroplasties Using a Multiple Port Access Device” [Atty. Docket No.100873-319(END6489USNP)] and filed on even date herewith, all of whichare hereby incorporated by reference in their entireties.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is: 1-20. (canceled)
 21. A surgical method, comprising:positioning a retractor in tissue to form a pathway through the tissue;moving in a proximal direction a select one of a plurality of sealingelements in a substantially rigid housing relative to the housing, theretractor, and each of the other sealing elements, wherein the retractorextends distally from the housing, and each of the sealing elements isconfigured to receive a surgical instrument therein and form a sealaround the surgical instrument; and moving in a distal direction the oneof the plurality of sealing elements relative to the housing, theretractor, and each of the other sealing elements.
 22. The method ofclaim 21, further comprising moving each of the other plurality ofsealing elements in the proximal direction relative to the housing, theretractor, and each other; and moving each of the other plurality ofsealing elements in the distal direction relative to the housing, theretractor, and each other.
 23. The method of claim 21, furthercomprising advancing a surgical instrument through the one of theplurality of sealing elements; wherein the one of the plurality ofsealing elements is moved in the proximal direction before the surgicalinstrument is advanced through the one of the plurality of sealingelements.
 24. The method of claim 21, further comprising moving theplurality of sealing elements as a unit in at least one of the proximaldirection and the distal direction relative to the housing and theretractor.
 25. The method of claim 21, further comprising moving in alateral direction each of the plurality of sealing elements relative tothe housing, the retractor, and each of the other sealing elements. 26.The method of claim 21, wherein a flexible connector couples a base tothe housing; the base has the plurality of sealing elements seatedtherein; and moving the one of the plurality of sealing elements in theproximal direction and in the distal direction includes flexing theflexible connector.
 27. A surgical method, comprising: positioning acannula in a body of a patient, the cannula extending distally from ahousing with a single port therein; advancing a surgical instrumentthrough the single port of the housing and then into a passagewayextending through the cannula, the housing including a sealing elementthat forms a seal around the surgical instrument; and rotating anannular disc having the sealing element seated therein such that theannular disc, the sealing element, and the surgical instrument rotaterelative to the housing.
 28. The method of claim 27, wherein the cannulais flexible.
 29. The method of claim 27, wherein the surgical instrumentincludes an endoscope.
 30. The method of claim 27, further comprisingmoving the sealing element proximally relative to the housing to adjusta position of the sealing element relative to the housing; and movingthe sealing element distally relative to the housing to adjust aposition of the sealing element relative to the housing.
 31. The methodof claim 27, further comprising moving the sealing element laterallywithin the housing to adjust a position of the sealing element relativeto the housing.
 32. The method of claim 27, wherein the port includes aflexible ring having the annular disc seated therein, and the rotationof the annular disc includes rotating the annular disc within a grooveof the housing in which the ring is seated.
 33. The method of claim 27,wherein the port includes a first ring proximal to the annular disc anda second ring distal to the annular disc, the first and second ringsforming a seal between the annular disc and the housing.
 34. A surgicaldevice, comprising: a housing including a seal base that has a pluralityof sealing ports formed therein, each of the sealing ports having asealing element disposed therein that is configured to form a sealaround a surgical instrument inserted therethrough; and an adapterassociated with one of the sealing ports, the adapter being configuredto move between a first position, in which the adapter is attached tothe housing and the one of the sealing ports has a first effectivediameter through which a surgical instrument is insertable, and a secondposition, in which the adapter is attached to the housing and the one ofthe sealing ports has a second effective diameter through which asurgical instrument is insertable, the second effective diameter beingless than the first effective diameter.
 35. The device of claim 34,further comprising a retractor coupled to the housing and extendingdistally therefrom, the retractor being configured to be positioned intissue to form a pathway through the tissue.
 36. The device of claim 34,wherein the adapter is rotatably attached to the housing at a hinge. 37.The device of claim 34, wherein the adapter is pivotally attached to thehousing at a hinge.
 38. The device of claim 34, further comprising asecond adapter associated with a second one of the sealing ports, thesecond adapter being configured to move between a first position, inwhich the second adapter is attached to the housing and the second oneof the sealing ports has a first shape through which a surgicalinstrument is insertable, and a second position, in which the secondadapter is attached to the housing and the second one of the sealingports has a second, different shape through which a surgical instrumentis insertable.
 39. The device of claim 34, wherein with the adapter inthe first position the one of the sealing ports has a first shape, andwith the adapter in the second position the one of the sealing ports hasa second, different shape.
 40. The device of claim 34, furthercomprising an insufflation port configured to provide insufflation of abody cavity therethrough; wherein the adapter is configured to movebetween the first and second positions without loss of the insufflation.